2019 GUIDELINES FOR EXERCISE DURING PREGNANCY
Here’s an (unbelievable) real story.
Once upon a time, maybe six years ago, a lovely pregnant woman sat in my office for a consultation. As always, I asked her about her current activity. She said she’d been told by her doctor to not exercise. Why was this? Was she high risk, I asked? Nope. Was she moderate risk? Nope. Any risk? No. Previous miscarriages? Infertility? No and no. Did she have any medical conditions at all?
No. NOTHING.
Her doctor had simply scoffed when she asked about exercising during her pregnancy, telling her it wasn’t needed. Of course, this patient didn’t quote her doctor’s words exactly to me, but it didn’t matter, the message to this woman, from her doctor, was clear:
you are pregnant and you should not bother with exercise. The end.
The problem is my patient’s experience is not uncommon, even today, years later. I read a comment on social media just the other day from a (pregnant) woman asking if anyone knew if it was recommended that she continue exercising through her pregnancy. And then there are the countless women that I’ve seen who have been told to “slow down!!”, “take it easy!!” and to “cut way back” on their usual exercise. Others have been told or read that they should not start any activity that they don’t currently do (“nothing new!”).
Sadly, so many women who are simply not informed of the benefits of exercise during pregnancy.
Of course, these messages will apply to many women, and each mumma must be provided with safe guidelines to follow, but generally the message that exercise is not important during pregnancy is a load of crap and it’s time to put this old falsehood (or fear) behind us.
Thankfully, the 2019 Canadian Guideline for Physical Activity throughout Pregnancy was released in October and it pretty much backs this up. FYI the guidelines had not been updated in fifteen years.
Here is a quote from the introduction of the 2019 guideline:
Unfortunately, uncertainty among some pregnant women and obstetric care providers as to whether prenatal physical activity may increase the risk of miscarriage, growth restriction, preterm birth, fatigue or harm to the fetus have served as barriers to being active. Concerns over harms have not been substantiated by research and the risks of not engaging in prenatal physical activity have not been adequately emphasized. Over the last three decades, the rates of pregnancy complications such as gestational diabetes mellitus, pre-eclampsia, gestational hypertension and newborn macrosomia have risen dramatically, most likely as a consequence of rising rates of maternal obesity.
2019 Canadian Guideline for Physical Activity throughout Pregnancy
“The RISKS of NOT engaging in prenatal physical activity have NOT been adequately emphasized.” Hopefully every primary care provider who has not been encouraging their pregnant mummas to move is now.
The guideline indicates that only 15% of pregnant women are meeting the new guideline. Yikes.
The details of the guideline are listed below, but here are the Coles Notes:
YOU MUST EXERCISE DURING PREGNANCY. You must work on strength. You must get your heart rate up.**
** Here is the obligatory note about contraindications (also listed below in more detail). If your doctor or midwife has told you that you cannot exercise for a MEDICAL REASON during your pregnancy, listen to them or seek a second opinion if you question their advice.
Before I copy and paste the new guidelines (below), here are some of the proven benefits of exercise during pregnancy (taken from the guideline).
Women who exercise during pregnancy can expect:
a 40% reduction in the chance of developing a major pregnancy complication such as pre-eclampsia, gestational hypertension or gestational diabetes
a 25% reduction in the risk of depression
These alone should be enough to get any pregnant mumma up off the couch, but here are a few other benefits that you may experience if you opt to exercise during pregnancy (not discussed in the current guidelines):
reduced back ache
reduced bloating and/or constipation
reduced incontinence (during and after delivery)
improved blood flow (swelling, restless leg)
improved mood
improved sleep
improved energy
improved muscle tone
faster recovery postpartum
better weight management
easier labour & delivery
you’ll feel better about yourself
you’ll get lots of smiles
you’ll have a smarter, calmer baby in your hands
If that last one isn’t enough!
6 RECOMMENDATIONS FOR EXERCISE DURING PREGNANCY:
As outlined by the 2019 Canadian Guideline for Physical Activity throughout Pregnancy.
All women without contraindication should be physically active throughout pregnancy
Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week
Physical activity should be accumulated over a minimum of three days per week
Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits
Pelvic floor muscle training (e.g. Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence
Pregnant women who experience light-headedness, experience nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position
CONTRAINDICATIONS
All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation.
The following are absolute contraindications to exercise:
Ruptured membranes.
Premature labour.
Unexplained persistent vaginal bleeding.
Placenta praevia after 28 weeks’ gestation.
Pre-eclampsia.
Incompetent cervix.
Intrauterine growth restriction.
High-order multiple pregnancy (eg, triplets).
Uncontrolled type I diabetes.
Uncontrolled hypertension.
Uncontrolled thyroid disease.
Other serious cardiovascular, respiratory or systemic disorder.
The following are relative contraindications to exercise:
Recurrent pregnancy loss.
Gestational hypertension.
A history of spontaneous preterm birth.
Mild/moderate cardiovascular or respiratory disease.
Symptomatic anaemia.
Malnutrition.
Eating disorder.
Twin pregnancy after the 28th week.
Other significant medical conditions.
You can download the full guidelines here.
Let’s hope that over the next fifteen years the percentage of mummas meeting these guidelines is far greater than the measly 15% who currently do. Let’s go mummas! You got this.
